Care transitions increase risk for medication errors. This meta-analysis found that pharmacist support during care transitions reduced medication errors and postdischarge emergency department visits. These results support a role for pharmacists in medication safety interventions for patients undergoing care transitions.

Journal Article > Study

Anticoagulants are considered high-risk medications due to their narrow therapeutic window and association with adverse drug events. This study suggests that integration of a clinical pharmacist into the inpatient team may help prevent anticoagulation dosing errors and resultant harm to patients.

Cases & Commentaries

Although meningitis and neurosyphilis were ruled out for a woman presenting with a headache and blurry vision, blood tests returned indicating latent (inactive) syphilis. Due to a history of penicillin allergy, the patient was sent for testing for penicillin sensitivity, which was negative. The allergist placed orders for neurosyphilis treatment—a far higher penicillin dose than needed to treat latent syphilis, and a treatment regimen that would have required hospitalization. Upon review, the pharmacist saw that neurosyphilis had been ruled out, contacted the allergist, and the treatment plan was corrected.

Journal Article > Commentary

Verbal orders can contribute to errors in medication prescribing. This commentary discusses the role of pharmacy technicians in managing verbal prescriptions and ensuring their correctness. The authors suggest that pharmacists can develop practice policies and institute communication techniques such as read-back to reduce risks associated with verbal orders.

Pharmacists play a crucial role in ensuring patient safety in hospitalized patients. However, prior studies have found inconsistent effects of medication reconciliation performed by pharmacists at preventing medication errors. This systematic review determined that pharmacist-performed medication reviews may reduce readmissions and emergency department visits after discharge, but the overall quality of the literature was not robust enough to definitively reach this conclusion.

Journal Article > Study

Pharmacists play a central role in medication safety. The authors present the results of the 2015 American Society of Health-System Pharmacists survey, which specifically looked at medication monitoring and patient education practices. The survey results support the growing role of pharmacists in counseling high-risk patients, discharge medication counseling, therapeutic drug monitoring, and medication order review.

This intervention study provided pharmacist support to perform medication reconciliation and care coordination for patients discharged from the hospital. Compared to similar-risk patients who did not receive the intervention, those who had medication reconciliation by pharmacists were less likely to be readmitted to the hospital. These results add to the existing literature supporting the utility of pharmacist-led care transition interventions.

Postdischarge pharmacist medication counseling has been shown to prevent readmissions. This randomized controlled trial of pharmacist-delivered telephone medication counseling did not show any difference in appropriateness of medication use. The authors noted the high frequency of inappropriate medication use overall.

Medication discrepancies during hospital admission are common and can lead to preventable harm. This study examined the impact of having a pharmacist review medical charts of patients with complex medication regimens who were admitted to a general medical or emergency short-stay unit. The authors found that partnering medical staff with a pharmacist to review patients' admission medications in the chart significantly decreased inpatient medication errors.

Adverse events following hospital discharge can lead to costly hospital readmissions. This study demonstrated a modest decrease in readmissions following implementation of pharmacist-led medication reconciliation and postdischarge telephone calls. These results are consistent with prior studies that determined pharmacist support can help reduce readmissions.

This retrospective study found that pharmacy technicians were able to collect a more accurate medication list for patients in the emergency department compared to the usual medication list obtained by other personnel. This finding suggests that better integration of the pharmacy team into emergency care could improve patient safety, consistent with previous studies investigating the role of pharmacists in emergency departments.

Journal Article > Study

In this study performed in a community behavioral health center, medication reviews by pharmacists helped improve appropriate monitoring of patients prescribed high-risk psychotropic medications. A WebM&M commentary describes a case of a potentially harmful medication error in an outpatient psychiatry clinic.

This randomized controlled trial at two academic medical centers studied the potential benefits of providing pharmacist medication reconciliation and counseling, along with individualized telephone follow-up after discharge, for adult patients hospitalized with acute coronary syndrome or acute decompensated heart failure. This extensive intervention did not reduce readmissions or emergency department visits within 30 days of discharge, though there was a small positive effect seen in patients with low health literacy.

Medication errors are a common cause of adverse events after hospital discharge. This randomized controlled trial found that integrating pharmacists into the discharge process improved patient satisfaction and reduced adverse drug events, emergency department visits, and readmissions in the 30 days after discharge. Pharmacists conducted medication reconciliation, provided patient education, and had multiple telephone contacts with patients after discharge.

Book/Report

Errors in the prescription, preparation, and administration of medications hinder safe patient care. This book summarizes theories and international practices to provide clinical pharmacists with strategies to address barriers to medication safety.

Journal Article > Study

Medication errors are a well-recognized source of preventable patient harm and result from mistakes made during medication prescribing, transcribing, dispensing, and administration processes. This study looked at the impact of several factors on reducing medication errors in critical access hospitals. Investigators found that dispensing by an onsite pharmacist and the use of barcode technology for administration were both associated with a statistically significant reduction in medication errors.

This controlled study evaluated the effect of a protocolled pharmacist intervention—which included medication reconciliation and regular medication review—on medication errors in elective surgery patients. There was no difference in the incidence of adverse drug events compared to patients receiving usual care.

Journal Article > Review

Exploring the literature on efforts to reduce medication errors in hospitalized children, this systematic review examined five interventions, including introduction of computerized provider order entry systems, clinical pharmacist participation in the frontline care team, and implementation of barcode medication administration systems. Although the interventions showed some success, none of the studies found a significant reduction in patient harm.

In 2010, the Anesthesia Patient Safety Foundation recommended that hospital pharmacies supply premixed solutions or prefilled syringes of commonly used anesthetic medications. Despite this recommendation, this convenience sample of 34 children's hospitals across the United States found that the majority of medications administered by anesthesiologists in 2012 were still prepared by the provider at the bedside.